Book/Media Review: An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine

The well-published medical historian and pediatrician Howard Markel^1–7 has followed up his award winning book⁸Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892 (winner of the Arthur Viseltear Award for Outstanding Book in the History of Public Health in the Medical Care Section from the American Public Health Association) and his outstanding⁹When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed with a new blockbuster concerning 2 iconic physicians—Sigmund Freud and William Halstead. In the late 19th and early 20th centuries, both these men made groundbreaking advances in medicine and both researched the then new chemical cocaine and became addicted. The book opens by depicting the scene at the New York City Bellevue Hospital of a frantic cocaine-addicted Halstead abandoning an accident victim to his junior colleagues and departing for his home where he remained in a cocaine oblivion for several months. Markel vividly paints this picture for readers to set the stage for the subsequent chapters of this captivating book.

Markel weaves the stories in chapters alternating between Freud and Halstead, although he often draws parallels as when both men were working at the Vienna General Hospital and Medical School but apparently never met. Markel also does a masterful job of intertwining historical details from this exciting period of the flowering of scientific medicine in the United States and Europe. In chapter 3, Markel describes how the commercialization and worldwide distribution of pharmaceutical-grade cocaine turned the Detroit-based pharmaceutical firm Park, Davis and Company into a business powerhouse, such that the genius salesman behind the success, George Davis, had the financial wherewithal in 1885 to take over publication of the prestigious Index Medicus.^10,11 Chapter 4 describes Freud’s almost obsessive interest in the properties of cocaine (experimenting on himself), the publication of his treatise Über Coca,^12,13 his mistaken belief that cocaine could be used to cure morphine addiction (ultimately resulting in the death of his colleague and friend Ernst von Fleischl-Marxow), and his anger at being bested in 1884 by Carl Koller in the discovery of the anesthetic properties of cocaine for use in eye operations (cataract removal).¹⁴ Chapter 5 describes how Halstead perfected the use of cocaine as an injected local anesthetic for a variety of surgical procedures by experimenting on himself and thereby becoming hopelessly addicted. In chapter 7, Markel details the mesmerizing effect on Freud of the famous Parisian neurologist Jean-Martin Charcot during the period October 1885 to February 1886 when Freud enjoyed a fellowship at the Salpêtrière Hospital thanks to having received the prestigious Jubilee Fund travel grant from the University of Vienna. Freud’s interest was particularly piqued by the great diagnostician Charcot’s studies of hysteria and the use of hypnosis. Ever the showman, Charcot would hold grandiose Tuesday rounds as was depicted in the famous painting (hung at the Paris Salon of 1887, more than a year after Freud had left Paris) by Pierre-André Brouillet¹⁵ (Figure 1), showing Charcot demonstrating a hysterical patient^16–22 (Freud was so enamored by the painting that a lithograph reproduction by Eugène Louis Pirodon hung in his consulting room). Chapter 8 depicts the attempted rehabilitation of Halstead from his cocaine addiction during a stay at the Butler Hospital for the Insane in Providence, Rhode Island, and his subsequent early research work at the newly established Johns Hopkins Hospital and Medical School campus in Baltimore, Maryland, under the tutelage of William Henry Welch. In chapter 9, Markel details Freud’s development of his ideas about the interpretation of dreams, along with the complicated relationships Freud had with his colleague Josef Breuer, his sister-in-law Minna Bernays, and his confident Wilhelm Fliess. Chapter 10 describes the early years of Halstead’s development of the world-famous surgical services (including his introduction of surgical gloves) and surgical training program at Johns Hopkins Hospital, Halstead’s relationships with the other physicians at Johns Hopkins Hospital (particularly Howard Atwood Kelly and William Osler), and his marriage to surgical nurse Caroline Hampton. The final chapter on Freud (chapter 11) discusses his acrimonious split with Fleiss and its relation to Freud’s cocaine use. The final chapter on Halstead (chapter 12) discusses the iconic John Singer Sargent^26,27 painting The Four Doctors depicting Welch, Halstead, Osler, and Kelly, which symbolizes the origins of Johns Hopkins Hospital and the dawn of scientific medicine in the United States. There are extensive (56 pages) endnotes and references documenting the many points made by Markel in this remarkable book.

This book is entertaining and hard to put down, and I highly recommend it to anyone interested in the history of medicine. I believe that histories such as this are critically important for the field of complementary, alternative, and integrative medicine to understand the various personalities and events that led to many of our current health care practices.²⁸